Severe outcomes of malaria in children under time-varying exposure

Pablo M. Salazar (), Alice Kamau, Aurelien Cavelan, Samuel Akech, Arthur Mpimbaza, Robert W. Snow and Melissa A. Penny ()
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Pablo M. Salazar: Swiss Tropical and Public Health Institute
Alice Kamau: Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme
Aurelien Cavelan: Swiss Tropical and Public Health Institute
Samuel Akech: Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme
Arthur Mpimbaza: Makerere University
Robert W. Snow: Kenya Medical Research Institute (KEMRI)-Wellcome Trust Research Programme
Melissa A. Penny: Swiss Tropical and Public Health Institute

Nature Communications, 2024, vol. 15, issue 1, 1-9

Abstract: Abstract In malaria epidemiology, interpolation frameworks based on available observations are critical for policy decisions and interpreting disease burden. Updating our understanding of the empirical evidence across different populations, settings, and timeframes is crucial to improving inference for supporting public health. Here, via individual-based modeling, we evaluate a large, multicountry, contemporary Plasmodium falciparum severe malaria dataset to better understand the relationship between prevalence and incidence of malaria pediatric hospitalizations - a proxy of malaria severe outcomes- in East-Africa. We find that life-long exposure dynamics, and subsequent protection patterns in children, substantially determine the likelihood of malaria hospitalizations relative to ongoing prevalence at the population level. Unsteady transmission patterns over a lifetime in children -increasing or decreasing- lead to an exponential relationship of hospitalization rates versus prevalence rather than the asymptotic pattern observed under steady transmission. Addressing this increase in the complexity of malaria epidemiology is crucial to update burden assessments via inference models that guide current and future policy decisions.

Date: 2024
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DOI: 10.1038/s41467-024-48191-7

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